The Glasgow Coma Score (GCS) is a critical tool used by healthcare professionals to assess a patient’s level of consciousness. Developed in 1974 by Graham Teasdale and Bryan Jennett, the GCS provides a reliable and objective way to measure the severity of a brain injury. This blog will guide you through understanding and applying the GCS, complete with five practice scenarios to enhance your learning.

Understanding the Glasgow Coma Score

The GCS is composed of three components:

  1. Eye Opening (E)
    • Spontaneous (4 points)
    • To speech (3 points)
    • To pain (2 points)
    • No response (1 point)
  2. Verbal Response (V)
    • Oriented (5 points)
    • Confused (4 points)
    • Inappropriate words (3 points)
    • Incomprehensible sounds (2 points)
    • No response (1 point)
  3. Motor Response (M)
    • Obeys commands (6 points)
    • Localizes pain (5 points)
    • Withdraws from pain (4 points)
    • Abnormal flexion (decorticate posture) (3 points)
    • Abnormal extension (decerebrate posture) (2 points)
    • No response (1 point)

The total GCS score ranges from 3 to 15, with 3 being the lowest and indicative of deep unconsciousness, and 15 being the highest, indicating full alertness and orientation.

Steps to Assess GCS

  1. Eye Opening Response
    • Observe the patient’s eyes. If they are open spontaneously, assign 4 points.
    • If they open only when spoken to, assign 3 points.
    • If they open only in response to a painful stimulus, assign 2 points.
    • If they do not open at all, assign 1 point.
  2. Verbal Response
    • Ask the patient simple questions such as their name, location, and the date.
    • Fully oriented answers receive 5 points.
    • Confused responses but able to converse get 4 points.
    • Inappropriate or random words merit 3 points.
    • Incomprehensible sounds like groans get 2 points.
    • No verbal response gets 1 point.
  3. Motor Response
    • Ask the patient to follow simple commands like “squeeze my hand.”
    • Obeying commands gets 6 points.
    • If they do not follow commands, apply a painful stimulus and observe their reaction.
    • Localizing the pain (moving a limb towards the stimulus) scores 5 points.
    • Withdrawing from pain scores 4 points.
    • Abnormal posturing such as decorticate (3 points) or decerebrate (2 points) responses indicate severe brain injury.
    • No motor response receives 1 point.

Practice Scenarios

Here are five scenarios to practice calculating the GCS:

Scenario 1:

  • The patient opens their eyes only when you speak to them.
  • They are confused and disoriented when asked questions.
  • They localize pain when you press on their nail bed.GCS Calculation:
    • Eye Opening: To speech (3)
    • Verbal Response: Confused (4)
    • Motor Response: Localizes pain (5)
    • Total GCS: 3 + 4 + 5 = 12

Scenario 2:

  • The patient’s eyes do not open even in response to pain.
  • They make incomprehensible sounds when asked questions.
  • They withdraw their hand when a painful stimulus is applied.GCS Calculation:
    • Eye Opening: No response (1)
    • Verbal Response: Incomprehensible sounds (2)
    • Motor Response: Withdraws from pain (4)
    • Total GCS: 1 + 2 + 4 = 7

Scenario 3:

  • The patient opens their eyes spontaneously.
  • They are fully oriented and answer questions appropriately.
  • They obey commands to move their fingers.GCS Calculation:
    • Eye Opening: Spontaneous (4)
    • Verbal Response: Oriented (5)
    • Motor Response: Obeys commands (6)
    • Total GCS: 4 + 5 + 6 = 15

Scenario 4:

  • The patient does not open their eyes.
  • There is no verbal response.
  • There is no motor response to a painful stimulus.GCS Calculation:
    • Eye Opening: No response (1)
    • Verbal Response: No response (1)
    • Motor Response: No response (1)
    • Total GCS: 1 + 1 + 1 = 3

Scenario 5:

  • The patient opens their eyes in response to pain.
  • They are speaking in inappropriate words.
  • They exhibit abnormal flexion in response to pain.GCS Calculation:
    • Eye Opening: To pain (2)
    • Verbal Response: Inappropriate words (3)
    • Motor Response: Abnormal flexion (3)
    • Total GCS: 2 + 3 + 3 = 8

Conclusion

The Glasgow Coma Score is an essential tool for evaluating a patient’s level of consciousness, especially in emergency and critical care settings. By understanding and practicing the assessment, healthcare professionals can make informed decisions about patient care and treatment. Use the practice scenarios provided to hone your skills and ensure accurate and reliable GCS assessments.